Innovative Models of Care - Walgreens Healthcare Clinics

Innovative Models of CareWalgreens Healthcare Clinics

Sandra Ryan, Chief NP Officer and Clinical Advocate Take Care Health Systems

©2013 Walgreen Co. All rights reserved.

Agenda

• Overview of Walgreens as a Health and Daily Living Destination

• Evolution of the Convenient Care Industry/Retail Clinics

• Role of Convenient Care and the NP in the Retail Clinic

• Overview of the Role of NP Leadership

• Future Role of the Nurse Practitioners in Healthcare

• Walgreens Well Experience:

• Transforming the traditional drugstore to a health and daily living destination

• Vision: To be for everyone in America – the first choice for health and daily living, owning the strategic territory of “well.”

Walgreens Plays a Critical Wellness Role in Communities Across the Country

• With more than 8,500 multichannel points of care, Walgreens gives you the power of a national footprint with the reassurance of a personalized local presence

• Walgreens is the largest national provider of immunizations, second only to the US government

• Walgreens is the largest pharmacy retailer in the country, filling more than 21% of all scripts – more than any other pharmacy network

• 6.1 million customers visit Walgreens everyday

• Over 800 Clinics, in retail health outlets and worksite-based health and wellness centers, many in “med-deserts”

©2013 Walgreen Co. All rights reserved.4

Walgreens Healthcare Patient Touchpoints

180 Hospital Outpatient Pharmacies in major institutions such as Yale and Northwestern

WellTransitionsTM discharge solution significantly reduces hospital readmissions

Hospital System Solutions

National Network of Retail Pharmacies

8,200+ pharmacies employing 70,000+ trusted health care professionals

Located within 3 miles of ~65% of Americans = 6 M customers each day

Specialty Pharmacy

#4 in the Industry-17 integrated Specialty Health Programs

700 HIV Centers of Excellence

Infusion Services #1 infusion provider with 75 Rx & 100 Alternate Treatment Sites in 36 states1,400 nurses deliver infusions either at home or at our sites

Retail Clinics

Employer Health Centers

375 On-site health centers at employer locations; 40+ years experience160+ employer clients in 45 states; serving ~10 M employees at work

400 Healthcare Health Clinics located in Walgreens stores in 19 states + DC

1,500 NPs and 40 PAs; every clinic has a collaborating physician

Chronic and Acute disease management programs

• 5

©2013 Walgreen Co. All rights reserved. Confidential and proprietary; should not be re-produced or re-distributed.

• DRAFT- ACCOUNTABLE CARE SERVICES

©2013 Walgreen Co. All rights reserved. 6

Retail Industry-Healthcare Clinics

The Problem-A Broken Healthcare System

Primary Care — Will It Survive?Thomas Bodenheimer, M.D.

• “Family Medicine cannot fully succeed, nor will the needs of the public be met, without fundamental changes in the U.S. health care system.”

http://content.nejm.org/

8©2013 Walgreen Co. All rights reserved.

Facts

50 million Americans are uninsured, including 1 in every 8 children. (Census Bureau, 2010)

70% of Americans report they can’t get same-day appointments with their PCP. (Commonwealth Fund 2007)

29% of Medicare recipients (11.6 million people) have a hard time finding a PCP who accepts their insurance. (Commonwealth Fund 2007)

30% of Americans lack a regular source of primary care. (Commonwealth Fund 2009)

Almost half of all emergency room visits were non-emergent in nature or otherwise treatable in primary care settings. (Desypher Analytical Services, 2010)


Healthcare Access is in Crisis

• Limited access to routine and preventive care.

• Millions of consumers do not have an established physician relationship or health insurance.

• Health care costs are rising at unsustainable rates. Healthcare cost estimated to be 20+% of the GDP by 2020.

• Consumers are demanding convenience.

• These issues will worsen as the primary care shortage grows.


Disrupting the Traditional Model

Convenient Care/ Retail Care has been termed a “disruptive

innovation.”

http://www.flickr.com/photos/moggsterb/3581264504/

More than 390 Locations in 34 Markets, 21 States


-

• Atlanta

• Boulder

• Chicago

• Cincinnati

• Cleveland

• Colorado Springs

• Columbus

• Denver

• Ft Lauderdale

• Houston

• Indianapolis

• Jacksonville

• Kansas City

• Knoxville

• Las Vegas

• Lawrence

• Louisville

• Memphis

• Miami

• Milwaukee

• Nashville

• New Orleans

• New York City

• Orlando

• Philadelphia

• Phoenix

• Pittsburgh

• St. Louis

• Tampa

• Topeka

• Tucson

• Washington DC

• West Palm Beach

• Wichita


Industry Growth

• Growth in the number of clinics is anticipated in the coming years (Deloitte Center for Health Solutions, 2009)

• Scope of services is being expanded with an eye towards disease prevention and chronic disease monitoring and management.

• More hospitals and health systems now operate clinics than non-hospital companies, though the majority of individual clinics are still operated by non-hospital companies.

• Growth among hospitals is largely due to perceived benefits of the relationship in supplementing and extending existing care (RAND, 2010).



Personalized Quality Healthcare Made Easy

High-Quality• Evidence-based• Nurse Practitioners • Streamlined technology, E-prescribing

capabilities, transparency of quality metrics

Convenient• No appointment needed but can schedule

one• Open 7 days a week – evening, weekend,

and holiday hours

Affordable• Lower-cost access to care• Most major insurance plans accepted• Transparent Pricing


14

Delivering a Patient Centric Experience


• 260+ square feet

• Two exam rooms, with exam tables

• Restroom facilities nearby

• Most clinics conveniently located across from the pharmacy

• Professionally outfitted with state-of-the-art technology and medical equipment

• Electronic sign-in kiosks/LCD

• Patient queue, with wait time visibility

• Electronic Health Records


Growing Range of Services

Examples

• Flu shots

• Hepatitis A & B

• Meningitis

• MMR (Measles, Mumps, Rubella)

• Tdap (Tetanus, Diphtheria, Pertussis)

• Varicella (Chicken Pox)

• Zostavax (Shingles)

• Physicals (camp and sport)

• Health screenings HRA’s

• Medicare Wellness Exams

Examples

• High Blood Pressure

• Specialty Injection Services

• Asthma

• Cardiovascular conditions

• Chronic bronchitis

• Diabetes

• High Cholesterol

• Osteoporosis

Examples

• Strep throat

• Sinus infection

• Bronchitis

• Ear infections

• Urinary tract infections

• Seasonal allergies

• Minor burns

• Sprains/strains

• Skin rashes

• Cold and mouth sores

• Tick/insect bites and stings

• Wart removal



Exceptional Patient Experience

• ACCESS

• TRANSPARENCY

Wait times, patient satisfaction, and quality metrics transparency via Walgreens.com to guide patient choice

Cash prices, as well as insurance plans accepted, available via in-clinic signage and website- Most insurance plans accepted, including Medicaid - Affordable costs for cash paying patients

• Clinics can serve as a cost-effective alternative for overflow, after hours, and non-emergent needs

• Open 7 days a week, including weeknights

• Walk-ins welcome and appointments available



Exceptional Patient Experience

• SIMPLICITY

• PATIENT SATISFACTI

ON

• A simple, paperless check-in process and clear information about estimated wait time

• E-prescribing to allow access to patients’ pharmacy of choice

• On line and in clinic appointment scheduling available for patients

• Patient satisfaction is in the top 10% of Gallup Consulting’s consumer database

• Follow-up phone call within 48 hours of their visit• Health Care Clinic strongly engages more than three out of every

four patients, while the typical company that works with Gallup strongly engages fewer than one in four of their patients

• More than 95% of patients agree that “the Nurse Practitioner/Physician Assistant spent enough time with me” and “health matters were explained in a way that was easy to understand “



Clinical Excellence

• BEST-IN-CLASS

• PROCESSES

• WELL-TRAINED

• CLINICAL STAFF

• Use of evidence-based frameworks and expert review of clinical policies

• Quality benchmarked against national standards, such as HEDIS

• Clinic exceeds national HEDIS benchmarks in measured categories

• Chart review process, facilitated by EMR, includes both peer review and Collaborating Physician review

• Clinicians credentialed in accordance with NCQA guidelines

• Enhanced certification and education of our clinicians

• Accreditation Association for Ambulatory Health Care (AAAHC) accredited

EVIDENCE-BASED

RESOURCES

American Academy of Pediatrics. Pediatric Clinical Practice Guidelines & Policies (2012)

Red Book Online American Academy of Pediatrics (2012)

Harriet Lane Handbook (2012) Pediatric Book

DynaMed Online (2012)

Veterans Affair/DoD Clinical Practice Guidelines Online

Epidemiology & Prevention of Vaccine-Preventable Diseases, CDC (2012)

Sanford Guide to Antimicrobial Therapy (2013) Antimicrobial Therapy Incorporated

Griffith’s Education for Patients (8thEdition, 2011)

Skin Disease: Diagnosis and Treatment by T. Habif (2011)

Epocrates Interactive Online Premium (2012)

Cash, J.C., & Glass, C.A., Family Practice Guidelines, Second Edition

Yellow Book For Travel Vaccines, CDC, 2012


• 13.7-27.1% of all ED visits could take place at alternative sites.

• Potential $4.4 billion in annual cost savings.

An Alternative to the ED

Improving Access

As many as 40% of clinic patients report not having a PCP (Mehrotra et al. 2011)

Some hospital systems report their retail clinics are the largest entry point into their healthcare system. (Mehrotra et al. 2011)

~12 to 14% of all ED visits can be seen at convenient care clinics (Weinick et al. 2010; Mehrotra et al. 2008).

93% of patients report highly on the convenience (Wall Street Journal/Harris Interactive 2008).

Nearly 30% of the U.S. population lives within a ten-minute drive of a clinic (Rudavsky et al. 2008).

Decreasing Costs

• Retail clinics reduced ER use and costs for pediatric population, and reduced admissions and outpatient costs for patients with chronic illnesses (Parente n.d.)

• Costs of care at a convenient care clinic are significantly lower than those at an urgent care center, primary care office, or emergency department (Mehrotra et al. 2009; Thygeson et al. 2008).

• Blue Cross and Blue Shield of Minnesota eliminated co-pays for enrollees who used a clinic, citing $1.2 million in cost savings (Minneapolis/St. Paul Business Journal 2008).

• Retail clinics have a return visit rate comparable with standard medical offices - care is high quality and does not generate additional follow up utilization. (Rohner et al. 2012)

Peer Reviewed Quality Outcomes

Convenient care clinic providers adhere to evidence-based practice guidelines and exceed national benchmarks (Jacoby et al. 2010; Woodburn et al. 2007).

Quality scores and rates of preventive care offered are similar for convenient care clinics as for other delivery settings (Mehrotra et al. 2009).

• Convenient care clinics had a 92.72% compliance with quality measure for appropriate testing of children with pharyngitis vs HEDIS average of 74.7%; they also had an 88.35% compliance score for appropriate testing of children with URI vs HEDIS average of 83.5%. (Jacoby et al. 2010)


Role of Nursing in Retail Industry


Chief Nurse Practitioner Officer

Roots in military corps concept: Nursing is its own profession

1st in Retail Clinic industry

Executive voice of the NP—First NP leadership track in industry:•Clinical and Business leaders

- Design work-environment to meet patient and provider needs- Develop proprietary EMR made for NPs- Create shared governance model from the start- Emphasis on quality- Nursing leadership development

Challenges:• Bridging gap between clinical and business• Regulatory constraints

Visibility For NP’s

National representative of NPs for CCA• Creation of Quality and Safety Standards and Recommended Practices

• Implementation of independent certification program for CCA members

• Legislative representation to address role of NPs in retail model nationally

• Gaining visibility in the media and among third-party researchers as a valuable source

• Founding National Convenient Care Clinic Week; integrating convenient care into the national dialogue about healthcare and healthcare reform

• Launching the CCA Clinician Portal to support and engage clinic providers

• Establishing partnerships with major national publications; • Standardization of image of NPs in the retail industry

Robert Wood Johnson Executive Nurse Fellowship

Fellow of the College of Physicians Philadelphia


Future of Retail and Nursing


We have the wind beneath our feet !!

Affordable Care Act• In March 2010, President Obama signed the Patient

Protection and Affordable Care Act (ACA), into law. The law makes preventive care accessible and affordable for many Americans. While some provisions of the law have already taken effect, many more provisions will be implemented in the coming years.

• Enrollment begins October 1, 2013 for coverage beginning January 1, 2014 (U.S. Department of Health and Human Services).

Report Recommendations:

Nurses should practice to the full extent of their education and training

Services offered at retail clinics allows for

nurses to practice to the fullest extent of

their education and training within a retail setting.

Acute care

Preventive & wellness care

Chronic disease diagnosis & management

• The Future of Nursing- IOM

http://www.rwjf.org/


National Governors Report

The Role of Nurse Practitioners in Meeting Increasing Demand for Primary CareDecember 20, 2012

States could increase access to primary care for their residents by consider easing their scope of practice restrictions and modifying their reimbursement policies to increase the role of nurse practitioners in providing primary careReviews academic and policy-oriented literature and state rules governing nurse practitioners’ scope of practice to examine the extent to which:• Scope of practice rules, licensure and other conditional requirements vary

across states; • States’ rules and requirements deviate from evidence-based research of

appropriate activities for nurse practitioners; and • Changes to state scope of practice laws and regulations affect access to health

care and its quality.



Current Legislative Environment: What it means to the NP Role

Need for increased access: 30 +million more insured lives• Innovative models to address Physician shortage

- More Nurse-Managed Healthcare Centers - Innovative models with all electronic, interoperable processes

NPs are positioned to educate and implement wellness and preventive medicine – holistic care

Quality: Accountable Care organizations (ACO’s)• Rewards provider-led organizations that take responsibility for the costs

and quality of care received by their patients over time. • Will see increased partnering between health groups, including

collaboration with NPs

Retail clinics engage in creative partnerships (employers, community health centers, private sector, payors

Federal Funding: Nursing education grants and loan programs to strengthen nurse training programs GNE


Future is BRIGHT for Patients and NP’s

Bracing for Obamacare: Nurse practitioners fill doc shortage gap

Aug. 9, 2013

This is the first story in NBC's series "Quest for Care" exploring the shortage of health care providers as the Affordable Care Act rolls out.

August 14, 2013

Nurse Practitioners Seek Right To Treat Patients on Their Own Health Professionals in Five States Fight to Shed Doctors' Oversight


Change is the Future…our Role

From fee for service to value based programs, from face to face and the potential for telemedicine, from independent primary care practices to systems and from encounter based medicine to person based health.

We need to:

• Use Health Information to manage and coordinate care• Utilize all health professionals to their fullest extent• Collaborate to integrate services• Help other to Navigate the Change-Stay Patient Centerd• Strive for Healthy communities• Look to innovate to accelerate the pace of change

Tipple Aim Better Care, Better Health, Lower Cost

It’s time to look beyond the past, think about the present and be about the future

• *Photo courtesy of Keith Green DDS Family Dentistry

34

The FUTURE


“ Our deepest fear is not that we are inadequate. Our deepest fear is that we are powerful beyond measure…” It is our light not our darkness that most frightens us..as we let our own light shine we unconsciously give other people permission to do the same.” Nelson Mandela


35

The END

THE BEGINNING!

[email protected]


Health & Medicine

Innovative Models of Care - Walgreens Healthcare Clinics